HomeMy WebLinkAboutHealth Department Septic Approval PERMIT #:56-SF-1767000
STATE OF FLORIDA APPLICATION #:AP1293080
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
gr SYSTEM
RECEIPT #:
~Yc°°%Wmr, nocUMENT #:PR1063841
CONSTRUCTION PERMIT FOR: OSTDS Abandonment
APPLICANT: Linda LeMieux
PROPERTY ADDRESS: 5301 Orange Ave Fort Pierce,FL 34947
LOT: BLOCK: SUBDIVISION:
PROPERTY ID #: 2407-312-0010-000-6 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS,
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE 'APPLICANT TO MODIFY THE
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 100 ] GALLONS / GPD Septic existina CAPACITY
A [ ] GALLONS / GPD CAPACITY
N I ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:125Q GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ ] SQUARE FEET SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE [ ] [ / ] [ABOVE/BELOW]BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ ] [ / ] [ABOVE/BELOW]BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ ] INCHES
Have the tank abandoned in accordance with the following procedures:(a)The tank shall be pumped out.(b)The bottom of
0 the tank shall be opened or ruptured,or the entire tank collapsed so as to prevent the tank from retaining water,and(c)The
T tank shall be filled with clean sand or other suitable material,and completely covered with soil.Have the system inspected
H by the health department after it has been pumped and ruptured but before it is filled with sand and icovered.
E
R
SPECIFICATIONS BY: JAMIE L DI FRANCESCO _ TITLE:
APPROVED BY: a v ITnv. Sup 11 St.Lucie CHD
Victor Faconti
DATE xSSUED: 06/01/2017 EXPIRATION DATE: 08/30/2017
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
r 1.1.•. A? 293090 5E-1